Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from British Journal ofIndustrial Medicine, 1979, 36, 263-275

The Pearson Report-compromise or step towards effective and just compensation for disability?

J. M. COLLINSON From the Faculty ofLaw, The University, Newcastle upon Tyne NEJ 7RU

ABSTRACT The setting up of the Royal Commission on Civil Liability and Compensation for Personal Injury, its terms of reference and report are discussed. The main recommendations are detailed with brief consideration of their possible impact. The proposals are assessed and the philosophy and principles behind the reform, explicit or implicit in the Report, are considered. Finally, the extent to which the proposals can be a blueprint for later reforms dealing with compensation for disability in general is discussed.

The Report of the Royal Commission on Civil The Setting Up of the Commission and its Terms of Liability and Compensation for Personal Injury (the Reference Pearson Commission) was published in March, 1978*1 after the Royal Commission had worked for The Commission was set up in 1973 after the Report five years on the problems in this field of the law. of the Robens Committee on Safety and Health at Volume 1 deals with the issues involved in compen- Work, at a time when there was also much public

sating for personal injuries, detailing the proposals concern over whether, and by whom, compensation copyright. of the Commission for reform. Volume 2 gives the should be paid to children born handicapped as statistics and costings and includes statistical infor- a result of their mothers having taken the drug mation based on a household survey. Volume 3 is a thalidomide at a vital stage of the pregnancy. The comparative study of systems of compensation in terms of reference of the Commission required them other countries. To enable the Commission to to consider to what extent, in what circumstances examine the many different compensation systems in and by what means compensation should be payable existence or under discussion, groups of Commis- 'for death or personal injury suffered in five specified sioners visited a variety of countries, including circumstances: (a) in the course of employment; http://oem.bmj.com/ Canada, the United States of America, Australia, (b) through the use of a motor vehicle or other means New Zealand, Switzerland, France, the Federal of transport; (c) through the manufacture, supply Republic of Germany, the Netherlands and Sweden. or use of goods or services; (d) on premises belong- They also visited the International Labour Office ing to or occupied by another; or (e) otherwise at Geneva, the Commission of the European through the act or omission of another where Communities at Brussels and the Secretariat of the compensation under the present law is recoverable Council of Europe at Strasbourg. only on proof of fault or under the rules of strict

liability'.2 The Commission interpreted their terms of on September 24, 2021 by guest. Protected reference in such a way as to exclude property Received for publication 23 January 1979 damage, loss not resulting from death or personal Accepted for publication 9 May 1979 injury, and illness resulting neither from injury nor *The members of the Commission were: Lord Pearson, former Lord Appeal in Ordinary; Lord Allen of Abbeydale, former permanent Under-Secretary of State, Home Office; Lord Cameron, Senator of the College of Justice in Scotland; Mr Walter Anderson, former General Secretary, National and Local Government Officers' Association; Professor Norman Marsh, QC, former Law Commissioner; Professor Richard Schilling, former Professor of Occupational Health, London School of Hygiene and Tropical Medicine; Mr Ronald Sherman, Chief Actuary, Prudential Assurance Company; Mrs Margaret Brooke, former Vice-Chairman, National Federation of Women's Institutes; Professor Robert Duthie, Nuffield Professor of Orthopaedic Surgery, Oxford University; Mr Robert MacBrindle, QC; Mr Denis Marshall, solicitor, member of Council, Law Society; Professor Alan Prest, Professor of Economics, London School of Economics; Mr A. Sansom, Managing Director, Iron Trades Employers' Federation (retired); Professor Olive Stevenson, Head of Department of Social Policy and Social Work, Keele University; Mr James Stewart, WS; Mr Alan Ure, Director, Trollope and Colls. 263 Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from 264 J. M. Collinson occupational in origin, thereby excluding injury acts or omissions of another person, although this is suffered at home or in pursuit of leisure. The Report far from clear from the terms themselves, as the states that 'the terms of reference clearly do not majority of accidents occurring in the home in fact envisage as immediately practicable a comprehensive occur on 'premises belonging to or occupied by scheme dealing with all injuries, still less a universal another', heading (d) of the terms of reference. An scheme dealing with all incapacity whether caused by accident victim is often a member of the family of injury, disease or congenital defect3. an owner or occupier of a house, or he may be a One can criticise this standpoint in that, even tenant rather than the owner of a house. within these terms, the Commission were unduly restrictive. In any case, terms of reference are The Main Recommendations intended as guidelines only, not a strait-jacket: they are intended to show the main problem to be looked THE TORT ACTION at, but without necessarily excluding problems, which Throughout the Report the Commission appear to on close examination are then seen not only to be feel that they are recommending a system preferable relevant, but inextricably linked with the main to the present action in tort, yet they felt unable at problem. The Commission itself exceeded its terms that stage to recommend its abolition, in whole or of reference by recommending the introduction of in part. The decision on retaining the action in tort a new benefit for severely handicapped children, the is argued very briefly.5 Although the Report does extension of the industrial scheme to new examples not recommend its abolition, a number of modifi- of occupational illness and certain changes to the cations are proposed and a shift in emphasis to an present social security system (e.g. mobility allow- improved social security scheme, so that in future ance). They also urged the Government to reconsider tort should play a minor role compared to that of the entitlement to widows' benefit and the treatment social security. Whether it will have this effect in of the partially disabled, neither of which can be said practice is, however, by no means certain. The main to be within the terms of reference. It was also open modifications proposed are as follows: to the Commission to look at the wider issues even if these exceeded their terms of reference, if they felt (a) The ending of double compensation. It is within their terms recommended that social security should be fully that any recommendations original copyright. would be unsatisfactory without paying attention offset against the assessment of the corresponding to the wider issues. The Woodhouse Commission tort damages instead of 50% of these benefits for (Report of the Commission of Inquiry into Com- up to five years, as at present.6 This would prevent pensation for Personal Injury in New Zealand), the present double or overlapping benefit, for which looking at the same problem, refused to interpret its the Commission could find no justification, a step terms of reference in a restrictive way,4 because it with which few would disagree. felt the need to examine the problem ofcompensation

for disability in its widest context. It was thus able (b) Inflation-proofedperiodicpayments. It is recom- http://oem.bmj.com/ to pursue its enquiries in a much more far-reaching mended that damages should normally take the manner and to make more sweeping recom- form of inflation-proofed periodic payments in the mendations. most serious cases; the court being obliged to award Because any legislation brought into force as periodic payments in such cases, unless satisfied a result of the recommendations of the Pearson that a lump sum was more appropriate.7 This part Commission would not be limited in any way to of the Report was not unanimous, there being two these terms of reference, and because so many are dissenting opinions. Because an injured person would

agreed that some reform in this area is necessary, still be at liberty to settle his claim by agreement, on September 24, 2021 by guest. Protected it would surely have been better if the Commission and as Insurance Companies are almost certain to had been prepared to look at the whole area, by offer any settlement in the form of a lump sum for refusing to interpret its brief so restrictively. If it administrative convenience, this will introduce one really felt that it could not interpret it more widely, further element into weighing up whether to settle or it could still have looked at all the issues on the fight in court. If one pursues a case to Court, even basis that it could not do its job properly without if successful, the damages awarded would probably considering these, and without seeing how these not be in the form of a lump sum as they would be were affected by any recommendations made. The if one settled, and the Insurance Companies might Report could then have been framed accordingly. well use this as a further bargaining counter to The Commission decided that the terms of refer- obtain slightly lower settlements. The Commission ence precluded it from considering accidents which feel that Insurance Companies ought not to be occur in a person's own home and are not due to compelled to make settlements in the form ofperiodic Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from The Pearson Report-compromise or step towards effective andjust compensation for disability ? 265 payments, but hope that they might find encourage- Effect of These Proposals ment to do so if the awards in Court were made in The proposals for fully off-setting social security this form. This seems likely to be an unrealistic hope benefits against damages, and for abolishing dam- as many people prefer a lump sum, however desirable ages for pain and suffering for the first three months, periodic payments are in some ways. Such a claimant if fully implemented, would eliminate a large number is likely to be influenced by the argument that he oftort claims. Approximately 95 % ofall injured make should accept what the Insurance Company offers sufficient recovery within three months to be able to (because anything higher, awarded in Court would resume work, even if they have residual disabilities. not normally be in the form of a lump sum) even if This might, therefore, cut the total number of tort his professional adviser fulfils the duty of pointing claims substantially and some of the Commissioners out the advantages of periodic payments, as is clearly envisaged a gradual withering away of the suggested by the Commission. law of tort as a result of this. The proposed improve- ments in the long-term social security benefits for (c) Elimination of certain minor claims. It is victims of road or work accidents will result in many recommended, with one dissent, that there should low or average earners receiving benefits close to be a three-month time-threshold for damages for their actual loss of earnings. Because these benefits non-pecuniary loss.8 This would result in a saving of are to be deducted from any damages awarded in money from the compensation itself and admin- a tort claim, such persons would have little to istrative expenses, no damages being awarded for gain from pursuing an action in the Courts. For the pain and suffering and loss of amenity in the first higher earner, however, much could still be gained three months after the occurrence of the injury. from a claim in tort. While accepting that this would save money, any The suggested improvements in the method of other justification for it is not immediately clear. It assessing damages for future loss of earnings would is quite possible for someone to suffer pain for less particularly benefit the higher-than-average earner, than three months which is nevertheless very severe because of the inflation-proofing proposal. The no- and hard to bear while it lasts. It is by no means fault benefits proposed would leave him with a much self-evident that such a person is a less deserving larger loss of income not covered, and so, even with case for compensation in respect of the pain than the off-setting process, he would still be left with copyright. a person with much less severe pain which lingers on quite a large drop in income, which he might seek for six months. Arguments can be put in favour of to recover in a tort action. never awarding compensation for pain or suffering.9 It can also be argued that no compensation should be Strict Liability awarded for any loss for a short period, on the basis The imposition of strict liability is proposed for that this would save money which could then be certain cases: used for compensation for longer periods of dis- ability, and that most people can cope with a drop in (a) Vaccine-damaged children. The Commission http://oem.bmj.com/ income for a short period. The distinction in the appears to have changed their mind on this in Report is less easy to justify. It is clearly easier to succeeding paragraphs." One cannot but wonder at justify no award for loss of amenity for a short yet another special group being singled out for period, in that one can bear that for a short time, priority in the field of compensation. However especially if the loss is slight, while if it were sub- beneficial for the sufferers themselves and their stantial it would be likely to continue after three families, the cause of disablement as a whole surely months, when it would be compensatable. requires equal treatment. The problems of all children who are handicapped, and of their families, on September 24, 2021 by guest. Protected are similar, whether the damage be due to vaccine, (d) Changes in the assessment of danmges. It is to injury during or before birth from whatever recommended that fuller account should be taken cause, or to handicapping, from whatever cause, in of the effects of tax and inflation in assessing the childhood. The Commission itself admits this. One plaintiff's loss.10 However, there was a minority cannot help feeling that it is a further example of a view expressed here by several of the Commissioners pressure group being sufficiently vocal, so that to the effect that a lump sum was different in kind reformers and Governments are persuaded, with from a lost income, and that regard should be paid good intentions, of the need for alleviating hardship to this in assessing it to ensure that a plaintiff was or injustice without examining the main problem to not over-generously treated, especially as inflation see if it is equally unjust to single out such a group over a large number of years was a matter of for preferential treatment when others are equally conjecture. deserving. While medical knowledge is not yet able Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from 266 J. M. Collinson to show the cause of all such disabilities, there may because of their potential for causing death or well be other causes operating in Society generally personal injury and (b) those which although nor- which at least contribute to such. Even with vaccine mally safe might cause serious and extensive damage itself it is very difficult to determine whether casualties if they did go wrong.'5 Category (a) a person really has suffered damage as a result of the would cover, for example, explosives and flammable vaccine. The Commission attempt to justify the gases or liquids, while (b) would cover large public discrimination on the basis that vaccination is really bridges, dams, major stores and stadiums and other done to protect the community. Although the com- buildings where large numbers may congregate. munity does benefit indirectly, parents who agree to They propose a statutory scheme under which vaccination do so in the hope of protecting their certain things and operations would be listed in own child, and, if they know of the risks, weigh a statutory instrument, the controller of each these up with or without the help of doctors, with becoming strictly liable for death or personal little intention of benefiting the rest of the injury resulting from its malfunctioning. community. No criterion is given in the Report by which one can test whether an article has an unusually hazard- (b) Defective products. The imposition of strict ous nature. It would appear that it could even include liability for defective products is recommended, the motor vehicles and industrial machinery, but proposed scheme to be broadly in line with the obviously from the Report it was not intended to Council of Europe Convention and the EEC draft include such, although these certainly have potential directive**.12 It is proposed that both producers of for serious harm if not under 'close, careful and finished products and component producers be skilled' supervision. Personal injuries often result liable, but not general distributors, and that importers from the use of such because their operators are should be treated as producers. No financial limit is either careless, reckless or insufficiently skilled. The to be placed on the liability and it should not be examples given in the Report of explosives and a defence for a producer to prove that he had with- flammable gases differ from such only in that they drawn his product. The liability is to be subject to are most commonly operated or supervised by a cut-off period of ten years from circulation of the highly skilled persons; in other respects they are no

product. No special defence is to be allowed for more nor less likely to cause harm. copyright. development risks and no special treatment is The second category is certainly going to give rise recommended for the pharmaceutical industry, to a differential liability as the Commissioners despite their pleading for such. themselves saw.'6 If part of a bridge collapses and X is injured there would be strict liability (provided that (c) Research or clinical trials. The Commission the bridge was held to be a large public bridge) but recommend that strict liability should be imposed if X tripped on some part of the bridge which on any authority to whom a volunteer for research protruded, and if he fell, injuring himself or if the or clinical trials has consented to make himself bridge was held not to be sufficiently large, he http://oem.bmj.com/ available and who suffers severe damage from these would have to prove fault. Any fire in a large trials.13 building could be said to be potentially serious. It might be possible to argue that injuries suffered in (d) Movement of rolling stock. The introduction a fire in a public building where large numbers of of strict liability is proposed for injuries caused by people congregate (e.g. school, shop, hospital, the movement of rolling stock, but not in respect of factory) could give rise to a claim under strict liability to trespassers.'4 liability. This would be so even if the accident was

caused by a negligent, criminal or malicious act of on September 24, 2021 by guest. Protected (e) Exceptional risks. The Commission recom- a third party, as this is to be no defence.'7 mend that some provision should be made for The potential of this particular provision cannot exceptional risks, proposing that strict liability have been realised, for it could increase strict should be imposed on controllers of things or liability litigation considerably, although the Com- operations (a) which, by their unusually hazardous mission themselves saw it more as a tidying-up nature require close, careful and skilled supervision operation. The Commission do not put forward any

**European Convention on products liability in regard to personal injury and death known as the 'Strasbourg Convention', adopted by the Committee of Ministers of the Council of Europe, Strasbourg at the session of 20-29 September 1976, open for signature on 27 January 1977. Proposal for a Council Directive relating to the Approximation of the Laws, Regulations and Administrative Provisions of the member states concerning liability for Defective Products (presented by the Commission to the Council on 9 September 1976). Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from The Pearson Report-compromise or step towards effective andjust compensation for disability ? 267 justification for extending strict liability in a field factory. The present special hardship allowance where hitherto it has played a negligible role. provides some recompense for the loss but is far from satisfactory because of the low limit on the Effect of these proposals benefit payable and the complex conditions applic- Apart from the abolition of the fault ingredient of able to the award.22 Sir Robert Micklewait (the liability, strict liability remains as before, liability in former Chief National Insurance Commissioner) tort, with all the normal requirements of such an suggested in his evidence to the Commission that action and all the hazards, costs and delays of the statutory provisions relating to this allowance litigation. The usual defences to such an action will required 'radical rethinking'. Having appeared be available and, because the legislation necessary sympathetic to this view, it seems strange that so to implement such proposals will be extremely little of the Report is given up to a discussion of this complex, with difficult borderlines created, there problem, especially as several members of the Com- will be ample scope for defendants to fight claims mission visited Australia where the Woodhouse even if more claims can be made. Commission intensively investigated this same problem.23 The Commission recommend that WORK INJURIES European provisions for compensating for partial The Commission concluded that the social security incapacity should be studied with a view to intro- industrial injuries scheme should remain essentially ducing such a scheme here. Once again the Com- as it was, but that it should be extended and mission were prepared to venture beyond what they improved. The main proposals in this field are as saw as their terms of reference, by suggesting that follows: the problem was one which extended over the whole field of injury and sickness. While most people would (a) Improved earnings-related benefits. The major agree that it is a wider problem, not restricted to advantage which the Report recommends for those those injured at work or on the road, it seems strange injured in accidents at work is entitlement to that in other areas the Commission were less pre- improved earnings-related benefits. For those entitled pared to go beyond their terms of reference or even to the long-term disablement pension there would be to comment on the wider area. an immediate right to the full earnings-related copyright. additional component of the new invalidity pension (d) Widows and widowers. The Commission pro- scheme,18 which other beneficiaries will acquire only posed the extension to widows under the work after 20 years.19 The result of this would be an scheme (and also the motor vehicle scheme) of the acceleration of entitlement to the increased benefits earnings-related advantages they proposed for the to be acquired by other beneficiaries later, the non-fatally injured. Widows' pensions would, there- advantage diminishing each year until 1998. fore, gain the benefit of the earnings-related sup- plement as if the deceased husband had been (b) An earnings-related supplement to short-term contributing to the new scheme for twenty years.24 http://oem.bmj.com/ injury benefit. The Report recommends that the They also recommend an increase in the earnings- benefit should comprise the existing flat rate benefit related supplement to the short-term widows' and an earnings-related supplement based on benefit in line with the adjustment to injury benefit.25 33j% of earnings between the short-term lower However, on the whole, the Commission felt that earnings limit and £30, and 25 % of earnings between widows should be treated alike and recommended £30 and the upper earnings limit.20 This latter that, in future, provision for widows in the industrial represents an increase from the present 15 %. This injuries scheme should be harmonised with provision would once again increase the differential between for other widows under the national insurance on September 24, 2021 by guest. Protected those injured at work (also extending it to those scheme. They suggest that the 'scaled benefit rates' injured in a motor vehicle accident) and those injured currently payable to widows between the ages of or disabled otherwise. The Report also recommends 40 and 50 under the national insurance scheme that the supplement be paid without contribution should be applied to industrial widows also. (This conditions,21 adding a further differential, because provision was introduced in the National Insurance contribution conditions are an essential prerequisite (Old Persons' and Widows' Pensions and Attendance to a claim for non-industrial benefit. Allowance) Act 1970 s.2, and is now in Social Security Act 1975 s.26(2) but was never made (c) Partial disability. The Commission clearly felt applicable to industrial injuries benefit.) Long-term that the present arrangements for dealing with partial pensions for widows benefiting under the industrial incapacity for work (i.e. where a person is able to injuries scheme have a preference of 55p a week over work but for reduced earnings only) were unsatis- pensions in the national insurance scheme. To aid Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from 268 J. M. Collinson harmonisation of the schemes the Commission fact that the Report considered that many prefer- recommend that this should be phased out and that ences should be retained or further increased for the the small pension (£4.59 a week at January 1977 employed person injured at work, as against his levels) payable to all widows in the industrial fellow-sufferer who is injured elsewhere or disabled injuries scheme who do not qualify for a full-rate through sickness, it is difficult to see why the pension because of age or family circumstances, possibility or desirability of an earnings-related should also be phased out but that pensions currently element for the self-employed injured at work in payment should not be withdrawn or reduced.26 should not have been considered, even if this did As a further step towards equal treatment for all place him in a preferential position as against his widows it is suggested 'that the Government should fellow-sufferer injured elsewhere or disabled through consider removing the contribution conditions for sickness. On their visit to New Zealand the Com- flat-rate widows' benefit under the national insurance mission must have been made aware of the special scheme'.27 Widowers are to be favourably treated problems the Accident Compensation Scheme there where the wife dies as a result of a work or motor had to resolve to try to provide a just solution to the vehicle accident. At present, benefit is payable only problems of the self-employed. (1) where the death of the wife arose from an industrial cause and (2) if the husband is incapable of (f) Commuters. The Commission recommend (by self-support. The Report recommends that the a majority of one) that accidents on the way to second condition be removed.28 Because the argu- and from work should be covered by the industrial ment put for this change is the alteration in the work injuries scheme.30 The main argument justifying this pattern of many families, and the realisation that was the fact that 60% of them would be entitled to many families rely on both incomes, it seems odd compensation under the proposed road accident no- that the Commission did not suggest that a similar fault compensation scheme. However, in view of the change ought to be made to the benefits payable to fact that railway undertakings would become widowers whose wives died as a result of some other strictly liable, giving some possibility of a remedy to cause. While this would have been beyond the terms rail users (albeit with the problems of a court action of reference as they were interpreted by the Com- instead of the more beneficial motor accident scheme)

mission, this reluctance to go beyond them was not and the majority of people who travel to work do so copyright. present when they suggested the removal of the by road, rail or on foot, the anomalies created by contribution conditions for widows under the excluding commuting accidents would be slight national insurance scheme, nor in some of their compared with all the anomalies still left, or even other recommendations. Where a husband and wife introduced, were the Report to be implemented fully. jointly contribute to the family income by paying for the mortgage, rates etc. out of their joint income, (g) Occupational diseases. The Commission recom- the death of either can be a financial disaster for the mended that an examination be made to see if other. For the widower who may have to pay for there was any means of reducing the time taken for http://oem.bmj.com/ someone to look after the children after school, in the prescription of occupational diseases. Where the school holidays, or when he is absent from home restrictive conditions operate for the prescription of due to his work, there will also be an extra financial certain occupational diseases it is recommended burden if his wife, when alive, was able to cope with that these should be removed in accordance with the this, despite employment. EEC Recommendation of 20 July 1966.31 The Commission also recommended that the mixed (e) The self-employed. In the Commission's view system of compensating occupational diseases the self-employed have been unjustly treated hitherto, should be adopted, so that the benefit would be on September 24, 2021 by guest. Protected deserving compensation from a work accident as payable, not only where disease comes within the much as employed persons. It is recommended that prescribed list, but also where the claimant could the self-employed should become eligible for dis- prove that his disease was occupational in origin, ablement benefit. Their unequal treatment is par- and a particular risk of his occupation.32 It did not ticularly marked as it is alleged that contributions feel able to recommend that a special scheme should by them to the national insurance scheme are not be set up for workers in the slate and other quarrying matched by the benefits availablb. Because of the industries. repercusssions both for sickness benefit and retire- ment pensions, neither of which provide for earnings- THE ROAD INJURIES SCHEME related benefit, it is proposed that, for the time The Commission recommend a 'no fault' compen- being, benefits to the self-employed and their widows sation scheme for motor vehicle injuries based on should be paid at a flat rate only.29 In view of the the improved scheme proposed for work injuries, Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from

The Pearson Report-compromise or step towards effective andjust compensation for disability ? 269 with rates of benefit at the same level.33 Special would at least provide some incentive to employers provision would be made in such a scheme for to be safety conscious. It can be argued that, in children and retirement pensioners,-34 while non- considering contributions by employees, not only earners would be entitled to the basic flat-rate should account be taken of the risk of being injured, benefits and disablement benefit for loss of faculty.35 but penalties and bonuses should also be applicable It would be confined to injuries caused by motor to encourage safety at work. This would be quite vehicles and incurred on roads or other land to which different from a scheme which penalised a worker for the public has access. carelessness by not granting him any compensation. Again, one feels that the Commission could have MEDICAL INJURY spent some time profitably while they were in New The Commission recommend that the progress of Zealand in investigating the problems in the New the no fault schemes in New Zealand and Sweden, Zealand system, the difficulties in introducing pen- which include compensation for medical accidents, alties there and in examining how the differential should be studied and assessed, so that the experi- rates between industries were working. ence could be drawn upon if it were ever decided to As far as road injuries are concerned, the method introduce a no-fault scheme here. However, for the of finance proposed by the Commission can also be time being they do not recommend such a scheme criticised. Because cars vary so much in their petrol for the United Kingdom.36 consumption there is little risk-relation in a petrol tax. Such a tax also penalises people who use their FINANCING OF THE SCHEME car a great deal (e.g. because they live in the country) The Pearson proposals retain the existing sources of yet there is little evidence that such persons are at finance for employment injuries. With one dissentient greater risk of injuring either themselves or other it is recommended that the industrial injuries scheme people. If the risk which should be relevant is that should continue to be financed by earnings-related of being injured, then passengers and pedestrians contributions from employers and employees, are also at risk and will not contribute at all to together with a contribution of 18 % from general a petrol tax. Of all road users the motor cyclist is at taxation. The increase in benefits is to come from greatest risk of injury (and because of this the levy increased contributions from employers only.37 The for motor cyclists has recently been increased in copyright. Pearson Commission give no arguments as to why New Zealand) yet under the Pearson proposals he employees' contributions should not be increased, will pay least towards the scheme. Where a vehicle is but only that from employers. Commuting accidents a Company car, the levy on petrol will effectively be would be financed from this source also. For road paid by the Company and not the person at risk, the injuries they recommend that the scheme should be driver. The levy for buses and heavy vehicles will be administered by the Department of Health and paid by employers, and indirectly by the public. The Social Security and that it should be financed by New Zealand scheme of levy provides for the a levy of about Ip a gallon on petrol.38 One of the possibility of a levy on drivers as well as owners, but http://oem.bmj.com/ Commissioners dissented from this levy and sug- this has not yet been introduced there and they still gested that a levy on insurance premiums was have not solved the problem of risk-relation, in that a superior method of finance. there is no provision for bonus or penalty premiums There is one dissent on the method of finance although this could also provide some incentive for proposed for work injuries, which states the case for care on the road, even if not a very effective one. If risk-related premiums,39 and a similar one on that it is felt that a levy should be related to the likely for road injuries.40 Where a premium is to be risk- cost, and risk, of being injured, the scheme becomes related, the question which must first be answered is very like compulsory insurance, the highest earners on September 24, 2021 by guest. Protected whether the risk to be taken into account should be having to pay most. If the levy were related to the the risk of injuring someone or of being injured. risk of injuring oneself or another it would be very Where the levy is on an employer, it can be only the difficult to assess this, but at least the disadvantage risk of one of his employees being injured which is of the previous example would be absent. A high- relevant, but it can be argued that a levy should take risk driver from the point of view of causing into account not only the risk of injury in that accidents, even if he has no dependants and a low particular industry but also the risk of injury in that income, would pay more than a low-risk driver with particular plant, something over which the employer a high income and several dependants, whereas in has some control. This could be done by differential the previous example the reverse situation would premiums in particular industries and by penalty and apply, and it would be essential to have penalty bonus premiums for particular plants. While these premiums and perhaps bonus payments for those might be difficult to administer, and costly, they with good records, to counteract this. In the end, the Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from

270 J. M. Collinson method of financing which is chosen will have to be be improved or extended, while certain new categories determined on policy grounds, and on this there will should be added (e.g. road accident victims). The be much room for argument as to the most just result of all this would be an incredibly complex method. The Pearson proposals neither bring out all system, each category having its own special con- the problems nor appear to have reached a very ditions for entitlement, its own level of benefits, and convincing solution to the problem of finance. its own methods of assessing such benefits. This The Commission were not prepared to remove the could result only in an increase in administrative tort action altogether and there certainly are prob- costs in total, and in overlapping categories with lems to face if this were to be done. However, if one many demarcation problems arising. Some categories retains tort and introduces a system of no-fault would have different machinery from others for both compensation one has the problem of increasing the general administration and appeals. number of possible beneficiaries from the scheme It is ironic that the one thing on which the Com- but without making any savings from the abolition mission seemed united was the fact that a system of the old scheme. Finance must then come from dependent on how an accident occurred (i.e. whether some new source, or else there must be an increase it was due to fault on the part of another person) was in the levies already paid, or a mixture of the two. no longer adequate or appropriate, yet the very The Commission has not given clear reasons for the recommendations which they made to remedy this choices made as to the sources of finance for the situation would result in a situation where it was proposals, and at times appears not to have clearly equally important to ascertain how the accident examined the problem of who ought to pay for the occurred. Their proposals would also result in any improvements, with the exception of the dissenting person who was injured in an accident at work, or on Commissioner. Nor has it considered whether there the road, and who subsequently suffered illness, should be penalties or bonuses within the scheme. trying very hard to link the one with the other, to gain the extra financial benefits. Assessment of the Main Proposals The Commission devoted Chapter 11 in the Report The Pearson Commission faced a very difficult task to 'Our Strategy' but it is difficult to find any clear in considering the problems inherent in our present objectives articulated here. It is obvious that the system of compensating those who are injured. In Commission was divided on many issues and one copyright. the end, quite apart from the decision as to whether can sympathise with them regarding the difficulties a country can afford to reform the law, a decision which inevitably arose from this, as well as the must be taken on how far collective responsibility for differences of opinion which were inevitable in such accidents or sickness should be adopted. Attitudes a large body. The problem is certainly not an easy on the desirability of such a widespread change will one to resolve, and one would be naive to imagine differ and it is therefore not surprising, even if a little that it has an easy or clear-cut solution. Some disappointing, that the Pearson Commission felt members of the Commission clearly indicated that unable to do more than propose certain compromises. they basically disagreed with the philosophy of the http://oem.bmj.com/ It was obviously concerned to make its proposals tort system and hoped that it would eventually reasonably acceptable to the various pressure groups wither away, while others indicated that they did within Society, and it was probably realistic to do so. not feel that the social welfare philosophy could be However, one wonders if it would not have been a total replacement for tort, holding that tort and successful in wooing such groups, as was done by private insurance still had an important role in the the Woodhouse Commission in New Zealand, had field of accident compensation. The resulting it put all the issues clearly before everyone in the Report was, inevitably with these divergent views, Report. a compromise. Added to this was the problem for the on September 24, 2021 by guest. Protected The limitation which the Commission placed upon Commission that, even if they could have found themselves by restricting their terms of reference a more comprehensive and radical solution to the made it impossible for them to suggest a radically problem which would have appealed to all members new scheme like the New Zealand Accident Com- of the Commission, such a solution would still have pensation Act or the Report of the National Com- needed to gain the support not only of the Govern- mittee of Inquiry into Compensation and Re- ment, but of all the pressure groups within Society habilitation in Australia, but it could, even within who would be affected by it. How far a Commission its own limits, have proposed a scheme which would should take this into account is very difficult to have been capable of extension to other groups later. decide, but it would be unrealistic to imagine that it The Commission recommend that the existing could avoid being influenced to some extent by it, arrangements for compensating injured persons particularly as many of the groups with a strong should all be retained, but that some of them should view on the matter will have given evidence before Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from The Pearson Report-compromise or step towards effective andjust compensation for disability ? 271 the Commission. However, even with sympathy for would be to cover accident and sickness. the difficulties facing the Commission, one cannot An argument used to support the case for pro- but feel that the Report abounds with compromise viding compensation for all persons injured in road and inconsistency, and has introduced further accidents, even if other accident victims are less well favoured groups forcompensation without giving any provided for, is that motor accidents are more real justification for compensating them rather than common, with the result that the public demands the groups not so favoured. that compensation should be provided for such Few would argue that the present system is really victims.4' Even if public clamour is greater for this adequate, but there are several possible ways of reform than for a reform of compensation payable tackling the problem. One could improve the present in respect of sickness or other forms of accident (and system simply by trying to speed up the judicial it is suggested that it may be the clamour of a few process, but this would only tinker with the problem, individuals together with the media, rather than the not tackle it at its roots. public at large), should not the determining factor Alternatively, one could try to make a major be whether the one is justifiable as a more pressing reform in this area. One view frequently expressed reform than the other, not whether public clamour is is that it is better to make a start in reform by greater for the one than the other? It has also been improving the position of employed persons who argued that English law already accepts liability suffer accidents, and road accident victims, because without fault where special circumstances have been they are already dealt with by the law, but in- made out,42 but, as stated earlier, this is so in the adequately, thereafter introducing new legislation field of personal injuries in only a few cases. The for other groups not provided for at all. This may argument itself implies the need to make out a special have been the philosophy behind the Pearson case for such, yet no case has been made. proposals. However, it is submitted that it is still A further possibility is to compensate all accident necessary to justify this improvement, as a more victims, irrespective of the cause of the accident and pressing need than that of the others for whom no of whether employed, but here again one can see provision is yet to be made. Can a case really be injustice. It appears difficult to justify compensating made to justify compensating those injured in road the wage earner of a family which has suffered as accidents, but who at present receive no com- a result of his being severely disabled in an accident copyright. pensation (because they cannot prove fault on (e.g. by a golf ball blinding him on the golf course, another's part) and compensating those injured in an in a situation where he cannot prove fault) yet not accident at work, or on the way to work, yet not compensating or compensating less well, the wage compensating a person suffering an accident outside earner of a family when he is severely disabled as the these categories? The financial and other needs of result of a stroke suffered on the same day on the the person and their family are identical, and once same golf course. Some people may well be accident one jettisons the fault principle, the only justification prone just as others are sickness prone. The merits for compensation must surely be that the person of the one are no less than the other; each is unfor- http://oem.bmj.com/ ought to be compensated in our Society because he tunate in a similar way. Of course, it might be argued and his family are in need of this. Is the housewife that sickness is peculiar to the individual, a problem or child or retired person or unemployed person concerned with his own anatomy, a misfortune, but injured in an accident, other than a road accident, something with which his neighbours or the State but unable to prove fault, less deserving of com- cannot be expected to assist. Yet could it not also be pensation, or less in need than when injured in said that an accident is personal, in a sense, in that a road accident? another person with a different reaction time might An argument sometimes used to justify covering have avoided it? Could it not be argued that, since on September 24, 2021 by guest. Protected accidents at any time or in any place to employed there is now some medical evidence to suggest that persons is the avoidance of the determination in our total environment is at least partly responsible each case of whether a person sustained the injury for some diseases, the State should have neither more 'in the course of his employment'. It is certainly true nor less responsibility for assisting persons disabled that this problem would vanish, but, unfortunately, in this kind of 'accident' than persons disabled in another one would take its place. One can envisage accidents in the more usual sense of the word? a large number of cases in which a person would If one is just tinkering with the problem, then it maintain that an illness from which he was suffering is justifiable to continue to provide for the categories could be traced back to, or had been aggravated by, already provided for, but by improved measures, and an accident suffered several years ago, some of the even to extend such categories very slightly for cases requiring considerable investigation, medical administrative and social advantage. If, however, and otherwise. The only way to avoid such problems one is making a fresh start, or at least is providing Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from 272 J. M. Collinson more comprehensive cover than before, it is necessary 1977, Mr Whitlam introduced the Bill as a Private to look not only at the categories already provided Member's Bill but the outlook even for this limited for, and to extend them slightly, but also to look at reform seems poor at the moment. the philosophy supporting provision for these cat- The Pearson Commission appear to have viewed egories but not for others. The proponents of cover the first choice within the second alternative as the for accidents but not for sickness tend to act as if, most appropriate one, and yet have nowhere made once one jettisons the fault concept for accidents, it out a case justifying the favoured treatment of these remains within the field of tort law, but this is not particular groups. If they were unable to justify really so, for with fault irrelevant the justification them and intended that they should simply be chosen must surely be on need, which brings it much more for special favour now, but with a view to the other within the realm of social security. Once that is seen less favoured groups being included later, they it becomes very difficult to exclude others whose need should have clearly stated their desire to see such an is similar, or to differentiate them by giving them extension, and planned the reforms they proposed in less adequate compensation. such a way that they could have been extended The Woodhouse Commission in New Zealand easily later. There are several places in the Report proposed cover for accidents to all persons, employed where the Commission do show an awareness of the or not (and this was ultimately implemented in the merits of more comprehensive cover and a wider Accident Compensation Act 1972 as amended by eventual goal. They were convinced that the social the Accident Compensation Amendment (No. 2) security system should be the primary source of Act 1973). It did so on the basis of a philosophy that compensation for injured persons, and this system the community had a responsibility for such has in recent years been moving towards the allevi- accidents. It admitted the difficulty of differentiating ation of the consequences of disability, irrespective accident victims from sick persons, and did not of cause.43 They also proposed a new benefit for attempt tojustify the one, simply stating that because severely handicapped children and suggested that of the difficulties of costing compensation for sick- widows should be treated equally, both forms of ness, caused by lack of availability of satisfactory benefit to be based on need rather than cause. statistics, and because an investigation into this was However, this was marred by their special recom- being made by another body, advancement by two mendations for vaccine-damaged children. copyright. smaller steps rather than one larger one was prefer- As far as eventual extension to other categories of able. It is unfortunate that the Pearson Commission the recommendation is concerned, that appears with all the statistical resources at its disposal inter- rather unlikely in the foreseeable future. By selecting preted its terms of reference so narrowly as not to for special and generous compensation certain include other accidents or sickness. categories of injured and disabled persons, according The final possibility would be not only to cover to the cause of their incapacity, and giving them all accidents, but also to compensate equally all a high level of earnings-related benefit together with victims of illness. Even if this could not be achieved disablement benefit for loss of faculty, the Com- http://oem.bmj.com/ immediately, it might be possible to make such mission have made it less likely that this will be alterations to our present system as would make the extended in the future. They have thrown away the eventual goal of a comprehensive system covering all concept of fault for certain accidents, but have given forms of sickness and disability easier to achieve. benefits not too dissimilar from those which would The National Committee of Inquiry in Australia was be given to a successful plaintiff in a tort action if he prepared to propose this as the important goal in could prove fault, at least if he was not a very high reform of this area of the law, and put up forceful wage-earner. By so doing they have made it much less arguments as to why this not only should be the goal likely that a Government will be persuaded to give on September 24, 2021 by guest. Protected but could, on the basis of statistics produced by equally generous compensation to sickness victims them, be achieved. When the Australian Labour who have never had the possibility of being able to Government was dismissed in November, 1977, sue successfully for such in the law of tort. a National Rehabilitation and Compensation Bill It seems inevitable that compensation, at the level was about to be introduced into Parliament, incor- at which it is awarded to a plaintiff successful in porating most of the changes recommended by the proving fault, could not be given to all and that there Senate Committee which examined the original must be some limitation to the amount of com- Bill attached to the Woodhouse Commission Report. pensation payable from a State fund. This then This new Bill limited compensation to accidents raises the problem of whether the tort action should only, showing just how difficult it is to convince be retained to enable the person still able to prove Governments of the justice of compensating victims fault to gain a complete indemnity. The Pearson of sickness as well as accident victims. In February Commission felt, on balance, that it should be so Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from The Pearson Report-compromise or step towards effective and just compensation for disability? 273 retained, at least for the present, but this immediately analysing them in the light of a new coordinating raises a problem. The Woodhouse Reports, in both policy. Nowhere in the Report is there a discussion New Zealand and Australia, and the academic of whether damages should be available for a young writings on the problem of compensation all seem childless widow, capable of earning her own living united in that to widen the scope of compensation and at present able to obtain a large Fatal Accidents requires extra funds to be available, and that the only award. Nowhere is there a discussion of whether place from which savings can easily come is admin- there ought to be a reconsideration of the present istrative costs in the tort action if such compensation six months' pension, which is what the same widow is abolished. A policy question is then immediately would receive under the social security scheme, if raised. Is it better that all of a group should be able unfortunate enough to have to rely on it. The to recover something, if injured (or suffering from Report conceded that common law damages are sickness, if that were to be covered also) even if some over-generous in minor cases and too low in major recover less than they do at present? The Com- cases, but fails to comment on the fact that the mission did not have to face this problem, as they disability benefits under the industrial injury scheme retained the tort action, but it would certainly have (a scheme the benefits of which they propose to to be faced if the scheme were to be extended to extend to victims of road accidents) can be criticised cover other groups who were disabled. It will be in the same way. Disability benefit for those with very interesting, if the Pearson proposals are serious injuries is not proportionately greater than implemented, to see just how costly will be the that for minor injuries. In addition, the person with administration of the mixed scheme of tort and social a 20 % disability or less will usually find that this has security which they propose. only a small effect on his life and that of his family, In a field where it is widely felt that some reform while the person with a 70% disability or more may is long overdue the Commission can rightly claim have to adapt to a completely new life-style, because that their proposals in aggregate would lead to this will almost certainly have a devastating effect on compensation for injured persons and their depen- himself and his family. As the more serious dis- dants being 'appreciably improved and extended'.44 abilities are less common than the more common The Commission express the hope that, in the future, minor injuries, it would have been very easy to have the close relation between compensation for the slightly reduced the compensation for minor injuries copyright. injured and bereaved provided by the law of tort and to increase the benefits for those with serious the social security system can be more clearly seen, injuries who need it most. with a shift in emphasis away from tort toward The Commission clearly accepted that com- social security, the latter becoming the principal pensation should be paid irrespective of fault in means of compensation, tort simply supplementing certain cases, yet they themselves categorise people it. This is certainly one of the more important aspects as entitled to support, not on the basis of whether of the report. For too long the two schemes have they have suffered an injury or disability, and are in been seen in isolation, although as has been said by need of compensation, but according to the circum- http://oem.bmj.com/ Elliott and Street (1968)4$: 'It is no exaggeration to stances giving rise to that disability. They do not state that the present tort system is endurable at all, justify the preference granted to work and road only because of the social security system. Although victims. With regard to work victims, it clearly was the tort system purports to be independent of the intended to avoid the trade union movement feeling social security system it would be seen to be an that members injured through work, whether due to utter failure if social security did not prop it up at the fault of the employer or not, might receive lower every stage.' However, whether the proposals 'would benefit, especially if the scope of the tort action were result in a better balance in the distribution of the to be reduced. This argument does not however on September 24, 2021 by guest. Protected funds devoted to compensation for personal injuries apply to road accident victims who, hitherto, had no and would give greater help to those who most need such remedy except in tort, and no preferential it', as is claimed by the Commission, is more arguable. treatment. This might well cause resentment to the The proposals certainly improve the present system, groups not so favoured, especially as their benefits but one can argue that it does little more than tinker will remain subject to contribution conditions, unlike with the problems, improving a bit here and there the favoured groups. but without looking at the whole problem of com- Perhaps the greatest inconsistency in the whole pensation in its wider context. Although the Report Report can be seen in the discussion on vaccine- talks of the desirability of coordinating tort and damaged children. In paragraph 1406 the Com- social security, the Report itself often fails to do this, missioners state that they do not think it right to even where an opportunity presents itself. It tends to distinguish one severely disabled child from another, accept the present position in certain cases without and that vaccine-damaged children should be con- Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from 274 J. M. Collinson sidered together with other severely disabled children, The Report itself is a bundle of compromises but irrespective of the cause of disablement. In the one can have sympathy with why this should be so. following paragraph they state: 'For those children Despite this, the Report is still a landmark, and while who can be shown to have been victims of vaccine it cannot, taken by itself, be a step in the direction of damage, we consider that there is a case for an compensation for all forms of disability irrespective additional remedy in the field of tort.' They go on to of cause, it may indirectly lead to this. If many of its recommend that the Government or local authority proposals are implemented and the fault principle is concerned should be strictly liable in tort for severe 'put to sleep', even if not killed outright, a new damage suffered by anyone (adult or child) as philosophy appropriate to the proposals may arise, a result of vaccination recommended in the com- that victims of disability are entitled to compen- munity interest. It almost looks as if the two sation because of their need and not because of paragraphs were written by two separate Com- another's fault. Should this happen, even if initially missions, so inconsistent do they appear. This to favoured groups only, the justice of the case of the recommendation has been accepted by the Govern- remaining victims must become apparent. A com- ment. promise today perhaps but, one hopes. a leap into the future tomorrow. Conclusions References The Pearson Report has performed a valuable service in authoritatively stating the case for some (All paragraph and chapter references are to Volume I of the reform in our present law of tort, as far as accident Pearson Report.) 'The Report of the Royal Commission on Civil Liability and victims are concerned. It has clearly underlined its Compensation for Personal Injury (1978) Cmnd. 7054. inadequacies and how important our present social Vol. I, Report, Vol. II, Statistics and Costings, Vol. III, security system is for accident victims. Perhaps the Overseas Systems of Compensation. HMSO, London greatest achievement of the Commission has been 2Para. 1 TPara. 3 the clear way in which it has enunciated its view that, 4Report on Compensation for Personal Injury in New Zealand, for too long, the law of tort and the social security December 1967. Government Printer, Wellington, New Zealand 1972. known system have been seen as separate and distinct, when (Also as the 'Woodhouse Report') copyright. the latter has been indispensable to the former. The 5Paras. 299-306 6Para. 482 Report has, at times, itself appeared not to see how 7Paras. 573 and 600 the schemes could be harmonised, but the clear "Para. 388 statement to the effect that it is no longer possible to "See dissent to the recommendation paras. 448-464 avoid integrating the schemes marks a step in a new °0Chapter 15 1Paras. 1406 and 1407 direction which was long overdue. No one who reads 2Chapter 22 this Report carefully can possibly fail to realise the 3Para. 1341

shortcomings of our present arrangements for 1Para. 1186 http://oem.bmj.com/ compensating victims of accidents. "Chapter 31 6Para. 1666 While having considerable sympathy for the 17Para. 1660 Commission in its very difficult task, one cannot but "Paras. 804-5 wish that it had spent more time on a discussion of "Social Security Pensions Act, 1975, ss.6 and 13 the ultimate goal for compensation for disability. So 20Para. 808 21Para. 809 often it appears to have seen many of the problems "2See para. 816 and 817 and Annex 6 and inconsistencies in the present law and yet has ""Report of the National Committee of Inquiry on Com-

failed to go beyond to discuss clearly where the pensation and Rehabilitation. Parliamentary Paper 100. The on September 24, 2021 by guest. Protected possible remedies lie. Because of the number of Government Printer of Australia, Canberra (1974), paras. 375-405 compromises made, the system proposed, while 24Para. 841 remedying certain of the defects, abounds with 25Para. 842 inconsistencies itself and continues to pay far more 26Para. 840 attention than is justified to granting preference for 27Para. 844 28Para. 846 particular groups. The result is that one's entitlement 2"Paras. 851-856 to benefit would still depend, to a large extent, not on 3"Para. 867 whether one had suffered some disability, but on 3"Paras. 877-879 how this had been caused. Many of the victims not 32Paras. 880-887 to "3Paras. 1004 and 1015 specially favoured in the Pearson Report will have 34Paras. 1021-2 and 1023-4 await another Commission or Committee of Inquiry "5Para. 1020 before their case is stated. 3'Chapter 24 Br J Ind Med: first published as 10.1136/oem.36.4.263 on 1 November 1979. Downloaded from The Pearson Report-compromise or step towards effective andjust compensation for disability ? 275 37Para. 904 42Ibid, p. 251 38Paras. 1051-1054 43Report on Security Provision for Chronically Sick and 39Paras. 940-948 Disabled Persons 1973-74, H.C. 276 40Paras. 1093-1102 44Para. 1732 41D. W. Elliott and H. Street (1968). In Law and Society, 45D. W. Elliott and H. Street, Op. cit., p. 247 Road Accidents, p. 249. Penguin Books, Harmondsworth

The August 1979 issue THE AUGUST 1979 ISSUE CONTAINS THE FOLLOWING PAPERS

Fatigue in industry E. GRANDJEAN A clinical survey of paraquat formulation workers J. K. HOWARD Mortality of chrysotile asbestos workers at the Balangero Mine, Northern Italy G. F. RUBINO, Amount and distribution of fume contaminants in G. PIOLATTO, M. L. NEWHOUSE, G. SCANSETTI, G. A. the lungs of an arc welder post mortem PIRKKO- ARESINI, AND R. MURRAY LIISA KALLIOMAKI, S. SUTINEN, V. KELHA, EEVA LAKOMAA, V. SORTTI, AND SIRKKA SUTINEN Thickening of pulmonary interlobar fissures: exposure-response relationship in crocidolite and Partition coefficients of some aromatic hydro- amosite miners A. SOLOMON, L. M. IRWIG, G. K. carbons and ketones in water, blood and oil AKIO SLUIS-CREMER, R. GLYN THOMAS, AND R. S. J. DU TOIT SATO AND TAMIE NAKAJIMA Mortality in gold and coal miners in Western The time course of mandelic and phenylglyoxylic Australia with special reference to lung cancer acid excretion in workers exposed to styrene under B. K. ARMSTRONG, J. C. MCNULTY, L. J. LEVITT, model conditions H. K. WILSON, J. COCKER, K. A. WILLIAMS, AND M. S. T. HOBBS C. J. PURNELL, R. H. BROWN, AND D. GOMPERTZ copyright. The relationship between coal rank and the pre- Carboxyhaemoglobin levels in workers in Leicester- valence of pneumoconiosis J. G. BENNETT, J. A. shire garages G. R. KELMAN AND T. J. DAVIES DICK, Y. S. KAPLAN, P. A. SHAND, D. H. SHENNAN, D. J. THOMAS, AND J. S. WASHINGTON Donald Hunter-the first Editor of the British Journal of Industrial Medicine R. S. F. SCHILLING Bronchoconstriction in potroom workers M. SARIC, http://oem.bmj.com/ E. ZUSKIN, AND M. GOMZI Book reviews Lung function in sisal ropemakers M. D. BAKER, Notices L. M. IRWIG, J. R. JOHNSTON, D. M. TURNER, AND B. N. BEZUIDENHOUT Information section Copies are still available and may be obtained from the PUBLISHING MANAGER, BRITISH MEDICAL

ASSOCIATION, TAVISTOCK SQUARE. LONDON WC1H 9JR, price £4-25 (USA $9.20), including postage on September 24, 2021 by guest. Protected